Physician Advisor in Dallas, TX at Pipeline Health

Date Posted: 1/9/2023

Job Snapshot

  • Employee Type:
  • Location:
    Dallas, TX
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Purpose: To define the items deemed necessary for an effective Physician Advisor role


Position Purpose/Summary

•       Purpose: Provides physician leadership and expertise related to care coordination, length of stay (LOS)/level of care (LOC) management, patient billing status management, denials management, care variation management, patient flow/throughput management, ancillary service utilization (e.g., lab and radiology) and clinical documentation improvement (CDI)

•       Policy-Setting Responsibilities: Responsible for reviewing and providing physician perspective for policies that relate to care coordination, care progression, patient access, care variation management, CDI, level of care management (LOC), patient billing status management, and denials management

•       Leadership Role: Responsible for assisting in meeting established goals, leading physician participation and physician compliance with responsibilities in care coordination, nursing, patient access, ancillary services, and CDI

•       Supervisory Responsibility: Responsible for encouraging engagement of physicians in care coordination, care progression, patient access, care variation management, CDI, LOC management, patient billing status management, and denials management activities



•       Reports To: TBD

•      Care Coordinator Director:  Formally responsible for working in a dyad with Care Coordination Director to meet the goals of the Care Coordination team

Duties and Responsibilities

1.     Inpatient Clinical Optimization: Care coordination, progression and variation

•       Serves as physician expert and provides support to care team and Care Coordination staff regarding utilization decisions including: screening for appropriateness of hospitalization, LOC, patient billing status management, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advice, and quality issues

•       Interacts with medical staff by seeking additional clinical information from physicians, discussing patients’ needs, suggesting alternative treatment options, and recommending next steps

•       Functions as a consultant and resource to all providers

•       Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation

•       Participates in daily interdisciplinary rounds, as needed, and supports care team communication and coordination activities

•       Supports care team, patient placement department and nursing supervisors by assisting with patient placement decisions (as needed), care/discharge delays, and patient throughput

•       Provides support to ancillary services departments (e.g., lab and radiology) by mitigating the inappropriate or unnecessary use of services

•       Participates in weekly Physician Advisor LOS rounds to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care progression

•       Prepares for and participates in (or ideally, chairs) monthly Utilization Management (UM) Committee

•       Documents patient care reviews, determinations and other pertinent information per hospital/Care Coordination policies

2.     Clinical Documentation Improvement

•       Provides support to CDI staff to assist with the clinical documentation query process, physician responsiveness, and comprehensiveness/accuracy of physician documentation (i.e., medical record documentation that reflects the full complexity of the clinical picture)

•       Provides instructional input and education to medical staff and CDI staff

3.     Regulatory and Accreditation

•       Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), DP, LOC, patient billing status management, and clinical documentation

•       Collaborates with hospital and quality department leadership to:

o   Ensure medical staff’s understanding and compliance with accreditation and regulatory management activities

o   Identify gaps in physician practice related to standards and regulations

o   Develop action plans to address identified gaps in regulatory requirements

o   Provide education and information to clinical groups regarding changes to practice and/or standards

o   Support quality improvement projects to streamline processes and address gaps

o   Prepare for surveys and participate in surveys, as appropriate

•        Works to ensure initial or continued accreditation through the following:

o   Collaborate with colleagues in quality and other departments to ensure all accrediting body requirements are met

4.     Maintains competence and professional development.  Maintains license, certification or registration as required. Meets continuous education requirements.

5.     Demonstrates behaviors that support performance improvement activities

6.     Performs other duties and attends committees as requested



Applicant Skills/Background

1.     Minimum Education/Training Required:

•       Graduate of an accredited medical school

•       Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)

2.     Experience:

•       Five years recent experience in clinical practice in a hospital strongly preferred

•       Two years administrative background as physician manager preferred

•       Previous experience as a physician advisor preferred

•       Experience leading large-scale change efforts preferred

3.     License, Registration or Certification Required:

•       Board Certified/Eligible Physician licensed

•       Utilization Review Physicians Certification (ABQAURP) preferred

4.     Knowledge, Skills and Abilities:

•       Strong clinical acumen

•       Knowledge of case management principles, processes, and their practical application preferred

•       Working knowledge of third-party payor guidelines/medical necessity criteria (e.g., knowledge of admission criteria for all levels of care)

•       Experience with denials management

•       Knowledge of clinical, quality, and administrative facets of the healthcare industry

•       Familiarity with clinical documentation requirements

•       Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Care Coordination

•       Excellent communication and presentation skills (both written and oral)

•       Teaching and coaching skills

•       Analytical ability and problem-solving skills

•       Working knowledge of electronic medical record

•       Knowledge of process improvement methodology

Note:  If individuals do not have one or more of these specific skills, they should have the aptitude and interest necessary to gain this knowledge

5.     Other Characteristics

•       Collaborative attitude to enable a strong partnership with Care Coordination

•       Clinical credibility among physician peers

•       Persuasive and influential personality

•       Engaging personality (e.g., enthusiastic, energetic, optimistic, personable)

•       Ability to follow through to completion